Special Populations

The "Tired" Athlete:

common causes

- Overtraining syndrome​

- Viral illness​

- Inadequate CHO/protein​

- Inadequate sleep​

- Depletion of iron stores​

The "Tired" Athlete:

less common causes

- Dehydration​

- Asthma (+/- exercise-induced)​

- Vitamin/mineral deficiency​

- Allergy​

- Jet lag​

- Psychological stress​

- Medications​

- Hypothyroidism​

What is "tired"?

- feeling lethargy

- impaired physical performance

What are two examples of overtraining from class?

2 female runners

- Grade IV tibial stress injury

- proximal tibia fracture

New term for "Female Athlete Triad"

RED-S

Epidemiology of RED-S

20-60% of female athlete

Is Low Energy Availability more common: endurance or aesthetic sports?

aesthetic sports

Risk Factors for RED-S:

- Sports with subjective judging or weight restrictions​

- Chronic dietary restriction or inadequate fueling ​

- Early sport specialization and high training volumes in adolescence​

Formula for Low Energy Availability

EA = (EI - EEE) / FFM

LEA energy level

< 30 kcal/kg FFM

Optimal energy level

45 kcal/kg FFM

Potential health consequences of RED-S

- immunological

- menstrual function

- bone health

- endocrine

- metabolic

- hematological

- growth + development

- psychological

- cardiovascular

- GI

RED-S Potential Performnace consequences

- decreased endurance performance

- decreased muscle strength

- decreased glycogen stores

- decreased concentration

- decreased coordination

- decreased training response

- increased injury risk

- impaired judegment

- irribtability

- depression

What is included in the thorough medical history for RED-S?

- past injuries

- menstrual changes (females)

- low libido (males)

key changes in medical history with RED-S

- dietary habits

- training load

- performance

- mood/weight

What is the physical exam for RED-S to identify?

musculoskeletal dysfunction

Who do you refer to with RED-S?

physician - medical management

dietician - nutrition counseling

Intervention for RED-S

- education

- adjust training load in collab with sports med team

- supervise training load in collab with coach

- monitor for changes in signs and symptoms

What is the assessment tool for RED-S?

Relative Energy Deficiency in Sport Clinical Assessment Tool (RED-S CAT)

Youth athletes usual ages

under 18

Examples of U-19 USA National Teams

- basketball

- soccer

- lacrosse

- baseball

- rowing

Pediatric Inactivity Triad components

- exercise deficient disorder

- physical illiteracy

- pediatric dynapenia

Pediatric Inactivity Triad:

exercise deficit disorder

less than 60 min moderate physical activity daily

Pediatric Inactivity Triad

physical illiteracy

decrease competence and confidence

Pediatric Inactivity Triad

pediatric dynapenia

decreased muscle strength and power

benefits of youth sport specialization

Fun​

Leadership​

Teamwork​

Self-esteem​

Physical activity​

Peer socialization​

degree of specialization:

low

0 or 1 of following:

year-round training (> 8 months per year)

chooses a single main sport

quit all sports to focus on 1

degree of specialization:

moderately

2 of following:

year-round training (> 8 months per year)

chooses a single main sport

quit all sports to focus on 1

degree of specilization:

highly

all 3 of following:

year-round training (> 8 months per year)

chooses a single main sport

quit all sports to focus on 1

risk of injury:

low specialization

low

risk of injury:

moderate specialization

moderate

risk of injury:

highly specialization

high

risk of serious overuse injury:

low specialization

low

risk of serious overuse injury:

moderately specialization

moderate

risk of serious overuse injury:

highly specialization

high

risk of acute injury:

low specialization

moderate

risk of acute injury:

moderate specialization

low

risk of acute injury:

highly specialization

low

thumb valgus force:

injury in adult

UCL sprain

thumb valgus force:

injury in child

fx or proximal phalangeal physis (SH III)

finger DIP joint hyperflexion:

injury in adult

mallet finger

finger DIP joint hyperflexion:

injury in child

fx of distal phalangeal epiphysis (SH II/III)

hand punching injury:

injury in adult

fracture of metacarpal head

hand punching injury:

injury in child

fx of metacarpal epiphysis (SH II)

fall on shoulder:

injury in adult

ACJ sprain

fall on shoulder:

injury in child

fx of distal clavicle epiphysis

shoulder abduction and ER:

injury in adult

dislocation

shoulder abduction and ER:

injury in child

fx proximal humerus epiphysis (SH I/II)

thigh/hip muscle strain:

injury in adult

acute quad/hamstring strain

thigh/hip muscle strain:

injury in child

apophyseal avulsion fracture

knee overuse:

injury in adult

patellar tendinopathy

knee overuse:

injury in child

Osgood-Schlatter

Sindling-Larson-Johansson

knee acute trauma:

injury in adult

meniscal/ligament injury

knee acute trauma:

injury in child

dx of distal femoral or proximal tibial epiphysis

avulsion tibiall spine

calcaneous overuse:

injury in adult

Achilles tendinopathy

calcaneous overuse:

injury in child

Sever's lesion

Most common MOI for tibial avulsion fracture

- Sports

- fall from bike

- MVA

- skiing

Growth Plate Fracture Type 1

a complete physeal fracture with or without displacement

Growth Plate Fracture Type 2

a physeal fracture that extends through the metaphysis

producing a chip fracture of metaphysis which may be very small

Growth Plate Fracture Type 3

a physeal fracture that extends through the epiphysis

Growth Plate Fracture Type 4

a physeal fracture plus epiphyseal and metaphyseal fracture

Growth Plate Fracture Type 5

compression fracture of growth plate

What type of growth plate fractures typically heal well?

types 1 and 2

What types of growth plate fractures have a high complication rate?

types 3 and 4

What is needed for recognition of growth plate fracture?

bilateral radiographss

T or F: Normal radiographs rule out growth plate fractures

FALSE

Legg-Calve-Perthes Disease:

age

2-13 years

Legg-Calve-Perthes Disease:

incidence

male > female

*rare in African Americans

15% bilateral

Legg-Calve-Perthes Disease:

observation

short limb

high grotch

quad atrophy

adductor spasm

Legg-Calve-Perthes Disease:

pain

gradual aching

hip, thigh, knee

Legg-Calve-Perthes Disease:

history

20-25% famial

Legg-Calve-Perthes Disease:

ROM

limited abduction and extension

Legg-Calve-Perthes Disease:

gait

antalgic after activity

Slipped Capital Femoral Epiphysis:

age

males: 10-17

females: 8-15

Slipped Capital Femoral Epiphysis:

incidence

male > female

black > white

Slipped Capital Femoral Epiphysis:

observation

obsese

short limb

quad atrophy

adductor spasm

Slipped Capital Femoral Epiphysis:

position

flexed

adducted

externally rotated

Slipped Capital Femoral Epiphysis:

pain

vague pain in knee

suprapatellar area

hip, thigh

Slipped Capital Femoral Epiphysis:

ROM

limited IR/abduction/flexion

Slipped Capital Femoral Epiphysis:

gait

acute - antalgic

chronic - trendelenburg

What are the tendon lengthening conditions?

Osgood-Schlatter disease

Sever's disease

Sinding-Larson Johannson disease

Osgood-Schlatter disease

patellar tendon/tibial tubercle

Sever's disease

Achilles tendon/calcaneal apophysis

Sinding-Larson Johannson's disease

patella-patellar tendon junction

General treatment reccomendations for tendon lengthening conditions

- activities

- stretching and soft-tissue mobilization

- modalities: ICE

Osteocondritis Dissecans

age

12-15

Osteochondritis disscans

seperation of articular cartilage from underlying bone (osteochondral fracture)

Most common sites for osteochondritis dissecans

- femoral condyle near introcondylar notch

lateral elbow (radial head or capitellum)

Less common sites for osteocondritis dissecans

- femoral head

- talar dome

Masters athletes

Athlete older than 35 years (age at which cardiovascular issues tend to become a greater cause of morbidity) who systematically trains for and competes inorganized forms of competitive sport specifically designed for older participants.​

Masters Athletes - Anatomic & Physiologic Changes:

body composition

- increase in abdominal girth

- reduction of lean mass

*athletes have a lower rate of decline of lean mass

Masters Athletes - Anatomic & Physiologic Changes:

muscle structure/function

- sarcopenia

- decline in # of muscle fibers, atrophy of remaining fibers *specifically type 2

sarcopenia definition

progressive decline of muscle mass, force generation, and quality associated with aging

Masters Athletes - Anatomic & Physiologic Changes:

changes in tendon structure INCREASES

- collagen crosslinks

- stiffness

- fibril density

Masters Athletes - Anatomic & Physiologic Changes:

changes in tendon structure DECREASES

- content of glycosaminoglycans and water

- fiber diameter

- tenocytes

**LOSS: crimp

Masters Athletes - Anatomic & Physiologic Changes:

cardiorespiratory fitness

decrease in max oxygen consumption, exercise economy, lactate threshold

After decade 5-30, what is the approximate decrease in VO2max?

10% per decade

What is the approximate rate of muscle mass decline?

1.25% per year, over age of 35

What is the change of strength ratio of type 2 to type 1?

1:1 to 1:2

***decreased rate of force development

When is the accelerated decline in peak strength?

over age 70